The risk of infectious disease outbreak after a quake is usually relatively low. The main risks come from poor water sanitation and crowding in temporary camps. These are present in Haiti (Time) (PBS). But, ALNAP, the Active Learning Network for Accountability and Performance in Humanitarian Action offers the following caution in its 2008 report on Responding to Earthquakes:

Agencies should not overstate the risk of disease, as this leads to the misallocation of resources, and promotes needless fear in an already traumatised population. This does not mean that precautionary measures such as water disinfection or disease surveillance are not necessary, but simply that the risk of epidemics, though real, is quite low.

The report recommends focusing on the particular problems that show up on the ground as opposed to trying to vaccinate against all possible threats. James Wilson has written on this site about some of the challenges and methods of biosurveillance. In recent crisis situations, disease outbreaks have been kept in check.

However, the Times points to another set of problems that come from the loss of medical infrastructure in Haiti.

The dire scene at Mr. Monfort’s clinic speaks to a larger concern: as hospitals and medical staff are overrun by people with acute conditions, patients who were previously getting treatment for cancer, H.I.V. and other chronic or infectious diseases have been pushed aside and no longer have access to care.

TB patients who don't receive their daily doses of medications and who have left the hospital for dense, tent cities are at risk themselves and could infect others.

To add one more slight complication to James' response: an additional issue specifically with TB (and to a lesser extent with HIV) is that interrupted treatment can lead to the emergence of resistant strains. One would really hope that the earthquake would not lead to further incidence of XDR-TB in Haiti.

I think it is important to highlight the difference between policy recommendations, which emphasizes not overly traumatizing the victims, versus prudence. The situation in Haiti is different from what was observed in Ankara, Sichuan, and other earthquake sites that contributed to WHO's stance on earthquakes and epidemics. For one, Haiti was already in an extremely fragile state whose indigenous population is malnourished with an already high infectious disease burden that includes HIV/AIDS.

I have seen some degree of confusion by laypeople reading our SitReps from the Haiti Epidemic Advisory System that highlight changes in risk that are occurring over time. These dynamic risks were actually present anyway as part of Haiti's background infectious disease ecology. Factors promoting enhanced disease transmission as a result of the earthquake may change the dynamic to creating a more favorable environment for epidemic occurrence.

Now, pre-earthquake Haiti dealt well with outbreaks and epidemics. By "dealt well", I mean it was a sad but locally accepted problem in Haitians' daily life. Part of being a Haitian, so to speak. But in this situation, where they have already lost loved ones to the earthquake, to lose more due to disease (even if locally normal, routine disease) is an additional emotional toll. Additionally, biosurveillance right now in Haiti is difficult due to lack of infrastructure. And that is when there has been minimal rain. Imagine how difficult it will be with the advent of the rainy season in March. If an outbreak or epidemic were to happen, response will be further compromised due to the rains, nevermind the issues of potential flooding and landslides.

So, the infectious disease risk in Haiti is a challenge of context. If it was an isolated issue, then it is manageable. But what little "control" that was achieved before is now completely up in the air when considering IDP camps, now zero infrastructure, a transient medical responder community, and in less than 30 days the start of the rainy season.... we may well have a mess on our hands soon enough.

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